Observational Pain Scales in Critically Ill Adults

Pain is a common and distressing symptom in critically ill patients. Uncontrolled pain places patients at risk for numerous adverse psychological and physiological consequences, some of which may be life-threatening. A systematic assessment of pain is difficult in intensive care units because of the high percentage of patients who are noncommunicative and unable to self-report pain. Several tools have been developed to identify objective measures of pain, but the best tool has yet to be identified. A comprehensive search on the reliability and validity of observational pain scales indicated that although the Critical-Care Pain Observation Tool was superior to other tools in reliably detecting pain, pain assessment in individuals incapable of spontaneous neuromuscular movements or in patients with concurrent conditions, such as chronic pain or delirium, remains an enigma.

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Reliability and Validity of the Face, Legs, Activity, Cry, Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients

American Journal of Critical Care ◽

10.4037/ajcc2010624 ◽

2010 ◽

Vol 19 (1) ◽

pp. 55-61 ◽

Cited By ~ 129

Author(s):

Terri Voepel-Lewis ◽

Jennifer Zanotti ◽

Jennifer A. Dammeyer ◽

Sandra Merkel

Keyword(s):

Critically Ill ◽

Rating Scale ◽

Intraclass Correlation ◽

Reliability And Validity ◽

Correlation Coefficients ◽

Assessment Tools ◽

Self Report ◽

The Face ◽

Critically Ill Adults ◽

Ill Adults

Background Few investigators have evaluated pain assessment tools in the critical care setting.Objective To evaluate the reliability and validity of the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Scale in assessing pain in critically ill adults and children unable to self-report pain.Methods Three nurses simultaneously, but independently, observed and scored pain behaviors twice in 29 critically ill adults and 8 children: before administration of an analgesic or during a painful procedure, and 15 to 30 minutes after the administration or procedure. Two nurses used the FLACC scale, the third used either the Checklist of Nonverbal Pain Indicators (for adults) or the COMFORT scale (for children).Results For 73 observations, FLACC scores correlated highly with the other 2 scores (ρ = 0.963 and 0.849, respectively), supporting criterion validity. Significant decreases in FLACC scores after analgesia (or at rest) supported construct validity of the tool (mean, 5.27; SD, 2.3 vs mean, 0.52; SD, 1.1; P < .001). Exact agreement and κ statistics, as well as intraclass correlation coefficients (0.67–0.95), support excellent interrater reliability of the tool. Internal consistency was excellent; the Cronbach α was 0.882 when all items were included.Conclusions Although similar in content to other behavioral pain scales, the FLACC can be used across populations of patients and settings, and the scores are comparable to those of the commonly used 0-to-10 number rating scale.

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Penetration of echinocandins into wound secretion of critically ill patients

Infection ◽

10.1007/s15010-021-01604-x ◽

2021 ◽

Author(s):

Tiziana Gasperetti ◽

René Welte ◽

Herbert Oberacher ◽

Jana Marx ◽

Ingo Lorenz ◽

...

Keyword(s):

Clinical Outcome ◽

Critically Ill ◽

Critically Ill Patients ◽

Plasma Concentrations ◽

Individual Variability ◽

Wound Infections ◽

Concentration Data ◽

Life Threatening ◽

Critically Ill Adults ◽

Ill Adults

Abstract Purpose Wound infections caused by Candida are life-threatening and difficult to treat. Echinocandins are highly effective against Candida species and recommended for treatment of invasive candidiasis. As penetration of echinocandins into wounds is largely unknown, we measured the concentrations of the echinocandins anidulafungin (AFG), micafungin (MFG), and caspofungin (CAS) in wound secretion (WS) and in plasma of critically ill patients. Methods We included critically ill adults with an indwelling wound drainage or undergoing vacuum-assisted closure therapy, who were treated with an echinocandin for suspected or proven invasive fungal infection. Concentrations were measured by liquid chromatography with UV (AFG and MFG) or tandem mass spectrometry detection (CAS). Results Twenty-one patients were enrolled. From eight patients, serial WS samples and simultaneous plasma samples were obtained within a dosage interval. AFG concentrations in WS amounted to < 0.025–2.25 mg/L, MFG concentrations were 0.025–2.53 mg/L, and CAS achieved concentrations of 0.18–4.04 mg/L. Concentrations in WS were significantly lower than the simultaneous plasma concentrations and below the MIC values of some relevant pathogens. Conclusion Echinocandin penetration into WS displays a high inter-individual variability. In WS of some of the patients, concentrations may be sub-therapeutic. However, the relevance of sub-therapeutic concentrations is unknown as no correlation has been established between concentration data and clinical outcome. Nevertheless, in the absence of clinical outcome studies, our data do not support the use of echinocandins at standard doses for the treatment of fungal wound infections, but underline the pivotal role of surgical debridement.

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Prevalence and risk factors for death in sepsis- associated brain dysfunction: a retrospective study from ICU admissions

10.21203/rs.3.rs-16897/v1 ◽

2020 ◽

Author(s):

Dao-Ming Tong ◽

Ye-Ting Zhou ◽

Shao-Dan Wang

Keyword(s):

Critically Ill ◽

Sofa Score ◽

Brain Dysfunction ◽

Clinical Predictors ◽

Icu Patients ◽

Risk Of Death ◽

Life Threatening ◽

Critically Ill Adults ◽

Qsofa Score ◽

Ill Adults

Abstract Background: The prevalence of sepsis-associated brain dysfunction (SABD) in ICU patients with critically ill remains unknown. We are to assess whether the prevalence of sepsis in ICU would present a high prevalent life- threatening SABD. Methods: We enrolled acute critically ill adults patients from ICU (from January 1, 2015, to January 1, 2017). All patients were selected from onset to ICU ≤3 hours and followed up to 30 day for sepsis patients who were treated in initial 48 hours or more in ICU. The predictors and risk of death of SABD was analyzed by multivariate models. Results: Of the 1349 ICU patients with acute critically ill, 748 were enrolled. Among these, the prevalence of sepsis was 48.4% (362/748). The prevalence of SABD accounted for 97.2% of sepsis (352/362), with fatality at initial 30 days was 73.6%. We found that the strong clinical predictors or markers for SABD were a SIRS ≥2 (OR, 3.2; 95% CI, 1.7-6.1), SOFA score ≥6 (OR, 3.0; 95% CI, 2.6-3.5), and qSOFA score ≥2 (OR, 0.34; 95% CI, 0.16-0.58). Cox logistic adjusted analysis revealed that lower mean arterial pressure (MAP) (OR, 1.5; 95% CI, 1.0-1.7)，higher SOFA score (OR, 1.8; 95% CI, 1.1- 1.9), and unused a rapid antibiotics treatment in initial 3 hours (OR, 0.7; 95% CI, 0.5-0.9) were the predictors of the risk of death among ICU patients with SABD. Conclusions: SABD is a leading life-threatening organ dysfunction following critically ill in ICU, with an high fatality. The predictors for worse survival SABD were related to the lower MAP, higher SOFA scores, and unused a rapid antibiotic treatment within initial 3 hours.

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